Provider Demographics
NPI:1952945214
Name:MADDEN FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:MADDEN FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:FAVA
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-738-0933
Mailing Address - Street 1:1545 HOTEL CIR S STE 270
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3414
Mailing Address - Country:US
Mailing Address - Phone:619-738-0933
Mailing Address - Fax:
Practice Address - Street 1:1545 HOTEL CIR S STE 270
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3414
Practice Address - Country:US
Practice Address - Phone:619-738-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty